Provider Demographics
NPI:1992254502
Name:PASQUA, BRENDA (ATC, EMT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PASQUA
Suffix:
Gender:F
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 KANAN RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-3904
Mailing Address - Country:US
Mailing Address - Phone:818-735-3303
Mailing Address - Fax:
Practice Address - Street 1:899 KANAN RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377
Practice Address - Country:US
Practice Address - Phone:818-371-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE084344146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic